Cognition, Medicare spending and mortality among the elderly

I propose to use detailed data from the Health and Retirement Study (HRS), linked to Medicare claims data, to answer these questions. The Medicare claims data are notoriously difficult to analyze and two months at the beginning of the study period will be devoted to learning to work with them. I have received permission from both the Health and Retirement Study and the Center for Medicare and Medicaid Services to use these restricted-access data, and the study protocol has been approved by the Institutional Review Board at the University of Michigan.

Specific study questions:

1. Does better cognition at baseline predict lower average annual Medicare spending per year of remaining life?

2. Does better cognition at baseline predict lower average annual Medicare spending per year of remaining life, controlling for existing physical health conditions at baseline?

3. Does better cognition at baseline predict lower total remaining lifetime Medicare spending per year of remaining life?

4. Does better cognition at baseline predict lower total remaining lifetime Medicare spending per year of remaining life, controlling for existing physical health conditions at baseline?

5. Does better cognition at baseline predict lower Medicare spending in the last year of life?

A. Does better cognition at baseline predict lower Medicare inpatient spending in the last year of life?

B. Does better cognition at baseline predict lower Medicare outpatient spending in the last year of life?

C. Does better cognition at baseline predict lower Medicare spending on services other than inpatient and outpatient care in the last year of life?